Individual
MARY EMBALABALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17586 KINCAID ST, ATHENS, IL 62613-7574
(217) 741-7832
Mailing address
17586 KINCAID ST, ATHENS, IL 62613-7574
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/15/2019
Last updated
03/15/2019
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